Clinical Manual for Public Health Dentistry and Practical Record Book DP Narayan
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1Clinical Manual for Public Health Dentistry
  • Chapter 1. Introduction
  • Chapter 2. Comprehensive Oral Health Care Planning
  • Chapter 3. Evaluation of the Patient for Comprehensive Oral Health Care
  • Chapter 4. Assessment of Oral Health Status Using Dental Indices
  • Chapter 5. Assessment of Oral Health Status Using WHO Assessment Form
  • Chapter 6. Preventive Dentistry
  • Chapter 7. Diet Counseling
  • Chapter 8. Management of Physically and Mentally Challenged Children
  • Chapter 9. Management of Medically Compromised Patients
  • Chapter 10. Preparation of Oral Health Education Material
  • Chapter 11. Field Program—A Visit to School
  • Chapter 12. Early Detection of Oral Cancer
  • Chapter 13. Early Detection of Dental Caries
  • Chapter 14. Setting up of a Private Dental Clinic
  • Chapter 15. Consent Letter
  • Chapter 16. Public Health Laboratory2

IntroductionChapter 1

We are all living in this wonderful world, which is changing everyday. The pattern of life of people is changing in this changing society. The overall population is increasing and within the population the relative age structure of the society is changing. The life expectancy of man is rising because of increased health care, better nutrition, sanitation and relief from communicative diseases. Thus, due to many other reasons, the relative improvement of general health shows a glaring contrast to the deteriorating situation in the field of oral health. This glaring contrast between general and oral health is very wide in developing countries.
In developing countries, the Public Health Dentistry should have been given due recognition and its rightful place. Unfortunately, the dental/oral health of people is not very good as is considered and it has not received due recognition and importance. An ordinary citizen knows very little about the oral health. The rural populations which constitute majority of our populations are socially and economically backward and quite ignorant about the benefits of good oral health. It is felt that very little efforts have been made to motivate and educate, the public about the oral health, to prevent the oral diseases in their early stages and to provide oral health services to public especially rural population.
Thus, the oral health of masses appears to be deteriorating in our country. The two main diseases responsible for premature loss of teeth and consequent crippling of the oral cavity, thus causing oral and general health problems are:
  1. Dental caries or decay, affecting teeth and
  2. Periodontal or advanced gum diseases affecting gums and supporting jaw bones. Both of these dental diseases are due to the presence of dental plaque.
Dental services which give priority to the treatment of oral diseases often do not reduce their prevalence. Program for oral health care must recognize the paramount importance of prevention, if they are to be effective and economical. Can traditional dental care, still be recognized as proper treatment? The facts seems to indicate that symptomatic dental treatment is a highly ineffective means of curing caries and periodontal diseases. Only people who live in major cities can get reasonable treatment for oral problems. Most rural and many poor urban communities have almost no access to even emergency care and relief of pain. For too many people dentistry is still “pain and pay”.
In order to bring down the disease prevalence and severity, it is important to implement organized oral health preventive programs at community level, as has been demonstrated in a number of Western countries, where the increasing trend in dental caries has been totally reversed. What is the explanation for the spectacular drop in caries prevalence in these countries? 4How can it be prevented from rising again? How can the worsening of the situation in other countries be halted? The reply to these questions is one and the same: Prevention, more prevention and still more prevention.
The proverb that “Prevention is better than cure” should be changed to “Prevention is the only cure”.
Each student should understand that wisdom implies a mature integration of appropriate knowledge and seasoned ability to filter the inessential from the essential. True knowledge exists in knowing that you know nothing. The scientist visualizes the world from this view point. His wisdom lies in his vision. His descriptive language has some unconventional words, which share some special thoughts and suggestions. If these atypical words, are not rightly understood by the teachers and taught, transfer of knowledge would be impossible. Therefore, in every textbook of science the first few chapters describe the categories to understand it better. No scientific textbook can be prescribed to the student without an initial chapter giving the description of terms and terminologies that have been used in the body of the book.
According to WHO, health is defined as “The state of complete physical, mental and social well-being, and not merely the absence off disease or infirmity”.
Public Health
In 1920, Charles Edward A Winslow, a former professor of public health at Yale University, USA, gave the oft-quoted definition of public health. The WHO Expert Committee on Public Health Administration adapting Winslow's earlier definition, has defined it as: “The science and art of preventing disease, prolonging life, and promoting health and efficiency through organized community efforts for the sanitation of the environment, the control of communicable infections, the education of the individual in personal hygiene, the organization of medical and nursing services for early diagnosis and preventive treatment of disease, and the development of social machinery to ensure for every individual a standard of living adequate for the maintenance of health, so organizing these benefits as to enable every citizen to realize his birth-right of health and longevity”.
Dental Public Health
The American Board of Dental Public Health modified the Winslow's definition of public health and defined dental public health as:
“The science and art of preventing and controlling dental diseases and promoting dental health through organized community efforts. It is that form of dental practice, which serves the community as a patient rather than the individual. It is concerned with dental health education of the public with research and the application of the findings of research, with the administration of programs of dental care for groups and with the prevention and control of dental disease through a community approach”.
Science of Dental Public Health
It is the concept that oral health services should be aimed at the community level rather than the individual patient. It involves the application of;
  1. 5Principles of epidemiology
  2. Principles of administration
  3. Social science health education
  4. Biostatistics
  5. Preventive dentistry.
After applying theses services scientifically community diagnosis is made and appropriate community treatment rendered.
Art of Dental Public Health
Just applying scientific principles and arriving at community diagnosis does not suffice. For successful community treatment, art of dental public health has to be developed. Essential features in acquiring this art are:
  1. To see that the ‘felt needs’ are given a priority
  2. To see that there is a wide co-operation between the oral health care beneficiaries and providers to utilize existing resources with maximum efficiency
  3. To see that the services are easily accessible
  4. To give a priority to high risk and vulnerable sections
  5. To make services available to all regardless of their ability to pay
  6. To see that dental health education imparted is easily comprehensible.
Application of the knowledge of behavioral sciences enables the practice of art of dental public health.
A suggested modification of Knutson's definition is “dental public health is a concern for and activity directed toward the improvement and promotion of the dental health to the population as a whole as well as of individuals within that population”.
Determining a Public Health Problem
Today, we can define a public health problem as an issue that meets the following criteria:
  1. A condition or situation or disease that is a widespread and majority of people are affected and is an actual or potential cause of morbidity or mortality.
  2. An existing perception that the condition is a public health problem on the part of the public, government, or public health authorities.
  3. Certain preventive and control measures are known or exist but these measures are not being implemented.
Objectives/Functions of Public Health Dentistry
The following are the major activities of public health dentistry:
  1. Health promotion for the entire population
  2. Dental public health education
  3. Conducting periodic dental and oral epidemiological surveys:
    1. To detect and eradicate or control those factors operating in the community, which are inimical to oral health, general health and well-being
    2. To assess the needs for dental care of the community
    3. To determine the priorities and statement of objectives
    4. To determine the available resources for program implementation.
  4. The improvement of community oral health by;
    1. Implementing effective preventive and therapeutic measures
    2. Deploying the available resources to meet the needs on the basis of priority
    3. The measurement of the effectiveness of present services and the planning of new services
    4. 6The co-ordination and integration of dental services and health services.
To fulfill the above mentioned objectives, we should arrange dental care programs such as—
  1. School dental health program
  2. Community dental health program
  3. Fluoridation of drinking water like school water fluoridation and community water fluoridation
  4. Topical application of fluorides
  5. Fluoride mouth rinsing programs
  6. Early detection of oral cancer program
  7. Monitoring and evaluation of programs
  8. Providing treatment services to persons who do not have easy access to general dental practitioners or hospitals, dental and oral health care for handicapped, physically, mentally and medically compromised patients
  9. Establish and maintain a community laboratory
  10. Co-ordinate and participate in the teaching of dental public health and preventive practices to students, teachers, health visitors, health educators, dieticians, nurses and doctors.
Dental Public Health Programs
James Morse Dunning has raised a number of important questions that must be addressed if a program is to be planned effectively, they are as follows;
  1. What are the dental needs of the community or population?
  2. What dental personnel are available to serve the population, and what is the political climate in regard to the type of staffing that can be used?
  3. How extensive is the demand for dental treatment in the population?
  4. What is the prevailing philosophy of the people regarding the extent of health care, they expect to receive and the manner in which they are willing to receive?
  5. To what extent will prevention of disease obviate the need for treatment? If in fact preventive measures could accomplish this, would they be acceptable for a particular society or segment of society?
  6. What scope of service will be offered in a public health program, who will receive the service, and in what manner will the service be delivered?
  7. How can the service be adjusted to reach more of the population?
What is Community?
The word “community” has a variety of meaning as follows:
  1. The term ordinarily refers to “the setting in which the dentist lives and practices his profession”.—Young and Stiffler.
  2. “A community as the ecologist would call it, biotic community is a more complex affair, embracing all population in a rather small geographic area, both plant and animal, including man”.—James Morse Dunning.
  3. “A body of people having common organization or living in the same place under the same laws and regulations.”This definition encompasses not only a city, but also would apply to a state, a region or the active nation”.—Webster's Third New International Dictionary.
What is Dentistry?
According to Indian Dentist Act, 1948:
  1. 7The performance of any operation and the treatment of any disease, deficiency or lesion of human teeth or jaws, and the performance of radiographic work in connection with human teeth or jaws, or the oral cavity.
  2. The use of any anesthesia in connection with any such operation or treatment.
  3. The mechanical construction or the renewal of artificial dentures or restorative dental appliances.
  4. The performance of any operation on or the giving of any treatment advice or attendance to, any person preparatory to or for the purpose of or in connection with, the filling, inserting, fixing, constructing, repairing, or renewing of artificial dentures or restorative dental appliances, and the performance of any such operation and the giving of any such treatment, advice or attendance, as is usually performed or given by dentists.
(DENTIST: Means a person who practices dentistry).
Community Oral Health
Is the organization of an array (regular arrangement) and range of promotive, preventive and curative oral health services required at individual and community level for the people living in a community.
What is Community Dentistry?
Community dentistry is mainly concerned with health promotion in the community and should be defined as: “That branch of dentistry, which is practiced in relation to population and groups; which derives from social sciences and epidemiology an awareness of the strategies and tactics required and which including the development of the techniques necessary for population diagnosis, planning and implementation of measures for the benefit of the community”. (Ref: Lars Granath and William, ‘Systematized Prevention of Oral Disease’: Theory and Practice - 1986. Page - 224).
Community dentistry has an important role in dissemination and implementing knowledge obtained from the natural sciences as well as the social sciences.
Epidemiology, particularly analytical epidemiology, is the instrument through which much of this information can be brought together, evaluated and systematized for the benefit of both individuals and the community at large.
Simple Definition of Community Dentistry
“It is the field concerned with the study of dental and oral health and disease in the population of a defined community”. Its goal is to—
  1. Identify the dental and oral health problems and needs of defined population, i.e. community diagnosis.
  2. To plan, implement and evaluate the extent to which dental and oral health measure effectively meet these needs, i.e. community treatment.
What is Community Diagnosis?
It is systematic investigation of community dental and oral health status and problems, through epidemiological surveys. Important data collected are;
  1. Demographic pattern of the community
  2. Socioeconomic condition of the people
  3. Incidence and prevalence rates of dental and oral health status and diseases
  4. Identification of dental and oral health problems and needs of population
  5. Identification of high-risk and vulnerable sections
  6. 8Resources of community, i.e. manpower, finance, time, place, material, etc.
What is Community Treatment?
It aims at working out plans, oral health programs and schemes for carrying out oral health and other services required to solve the community oral health problems.
Community treatment should stress on utilization of already existing resources of the community. Priority is to be given to the “felt needs of the people”.
Action in community treatment is aimed at 3 levels:
  1. Individual level
  2. Family level
  3. Community level.
What is Preventive Dentistry?
Preventive dentistry can be defined as “The science and art of promotion and application of measures to prevent the onset of oral and dental diseases and to treat these diseases in their early stages and prolonging life by promoting dental health as well as physical and mental health and efficiency for the individuals and families as well as groups and community”.
Preventive dentistry is defined as “The efforts which are made to maintain normal development, physiologic function and to prevent diseases of the mouth and adjacent parts”.—Blackerby.
Brauer stated that “Prevention as it applies to dentistry refers to the treatment or mechanisms which are employed to avert or intercept dental or systemic diseases which tend to destroy or make less oral tissues function”.
What is “Prevention”?
It is the process of interception or intervention to halt or prevent the onset of disease and treating the disease if occurs in early stages to prevent the complications.
Why should we Prevent Dental and Oral Diseases?
The following 3 main points gives justification to the prevention of dental diseases.
  1. Avoidance of pain
  2. Justification for oral and general health
  3. Economy of dental treatment.
Avoidance of Pain
The pain due to dental diseases is excruciating, very severe and unbearable and because of it there will be loss of attendance in school, loss of work, loss of income, loss of sleep, discomfort, etc.
Justification for Oral and General Health
Because of the following reasons:
  1. Mouth acts as doorway for food
  2. Mastication of food
  3. Phonation (speech)
  4. Deglutition
  5. Oral cavity acts as foci of infections—dental and oral diseases act as foci of infections, which lead to septicemia, bacteremia, bacterial endocarditis, cavernous sinus infection and oral infections, also spreads to other parts of the body.
Economy of Dental Treatment
Dental treatment techniques are more expensive than preventive techniques.
Principles of Prevention of Disease
Most of the dental and oral diseases are preventable. Successful prevention depends upon;
  1. 9A knowledge of causation
  2. Dynamics of disease transmission
  3. Identification of risk factors and risk groups
  4. Availability of prophylactic or early detection, preventive and treatment measures
  5. Organization for applying these measures to appropriate persons or groups
  6. Continuous evaluation and development of procedures to be applied.
Before planning for any preventive procedure, we should consider the following 3 principles:
  1. Natural history of disease
  2. Levels of prevention
  3. Awareness and use of appropriate preventive techniques or measures.